Universität zu Köln

di Biase, Lazzaro ORCID: 0000-0001-8753-757X, Brittain, John-Stuart ORCID: 0000-0002-4172-190X, Shah, Syed Ahmar ORCID: 0000-0001-5672-0443, Pedrosa, David J., Cagnan, Hayriye ORCID: 0000-0002-1641-115X, Mathy, Alexandre ORCID: 0000-0002-6082-8278, Chen, Chiung Chu, Francisco Martin-Rodriguez, Juan, Mir, Pablo ORCID: 0000-0003-1656-302X, Timmerman, Lars, Schwingenschuh, Petra, Bhatia, Kailash, Di Lazzaro, Vincenzo ORCID: 0000-0002-9113-5925 and Brown, Peter ORCID: 0000-0002-5201-3044 (2017). Tremor stability index: a new tool for differential diagnosis in tremor syndromes. Brain, 140. S. 1977 - 1987. OXFORD: OXFORD UNIV PRESS. ISSN 1460-2156

Full text not available from this repository.

Abstract

Misdiagnosis among tremor syndromes is common, and can impact on both clinical care and research. To date no validated neurophysiological technique is available that has proven to have good classification performance, and the diagnostic gold standard is the clinical evaluation made by a movement disorders expert. We present a robust new neurophysiological measure, the tremor stability index, which can discriminate Parkinson's disease tremor and essential tremor with high diagnostic accuracy. The tremor stability index is derived from kinematic measurements of tremulous activity. It was assessed in a test cohort comprising 16 rest tremor recordings in tremor-dominant Parkinson's disease and 20 postural tremor recordings in essential tremor, and validated on a second, independent cohort comprising a further 55 tremulous Parkinson's disease and essential tremor recordings. Clinical diagnosis was used as gold standard. One hundred seconds of tremor recording were selected for analysis in each patient. The classification accuracy of the new index was assessed by binary logistic regression and by receiver operating characteristic analysis. The diagnostic performance was examined by calculating the sensitivity, specificity, accuracy, likelihood ratio positive, likelihood ratio negative, area under the receiver operating characteristic curve, and by cross-validation. Tremor stability index with a cut-off of 1.05 gave good classification performance for Parkinson's disease tremor and essential tremor, in both test and validation datasets. Tremor stability index maximum sensitivity, specificity and accuracy were 95%, 95% and 92%, respectively. Receiver operating characteristic analysis showed an area under the curve of 0.916 (95% confidence interval 0.797-1.000) for the test dataset and a value of 0.855 (95% confidence interval 0.754-0.957) for the validation dataset. Classification accuracy proved independent of recording device and posture. The tremor stability index can aid in the differential diagnosis of the two most common tremor types. It has a high diagnostic accuracy, can be derived from short, cheap, widely available and non-invasive tremor recordings, and is independent of operator or postural context in its interpretation.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code di Biase, Lazzaro UNSPECIFIED orcid.org/0000-0001-8753-757X UNSPECIFIED Brittain, John-Stuart UNSPECIFIED orcid.org/0000-0002-4172-190X UNSPECIFIED Shah, Syed Ahmar UNSPECIFIED orcid.org/0000-0001-5672-0443 UNSPECIFIED Pedrosa, David J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cagnan, Hayriye UNSPECIFIED orcid.org/0000-0002-1641-115X UNSPECIFIED Mathy, Alexandre UNSPECIFIED orcid.org/0000-0002-6082-8278 UNSPECIFIED Chen, Chiung Chu UNSPECIFIED UNSPECIFIED UNSPECIFIED Francisco Martin-Rodriguez, Juan UNSPECIFIED UNSPECIFIED UNSPECIFIED Mir, Pablo UNSPECIFIED orcid.org/0000-0003-1656-302X UNSPECIFIED Timmerman, Lars UNSPECIFIED UNSPECIFIED UNSPECIFIED Schwingenschuh, Petra UNSPECIFIED UNSPECIFIED UNSPECIFIED Bhatia, Kailash UNSPECIFIED UNSPECIFIED UNSPECIFIED Di Lazzaro, Vincenzo UNSPECIFIED orcid.org/0000-0002-9113-5925 UNSPECIFIED Brown, Peter UNSPECIFIED orcid.org/0000-0002-5201-3044 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-226497
DOI:	10.1093/brain/awx104
Journal or Publication Title:	Brain
Volume:	140
Page Range:	S. 1977 - 1987
Date:	2017
Publisher:	OXFORD UNIV PRESS
Place of Publication:	OXFORD
ISSN:	1460-2156
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RE-EMERGENT TREMOR; PARKINSONS-DISEASE; CLINICAL-DIAGNOSIS; ACCURACY; SPECT; CEREBELLAR; ACTIVATION; DISORDER Multiple languages Clinical Neurology; Neurosciences Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/22649